I've been a medical/surgical nurse for over 6 months and no longer work with a preceptor. Recently, a physician ordered a surprisingly large dose of an opioid analgesic for a patient. I was concerned about possible respiratory depression. But the patient was in severe pain and I knew the physician would be hard to reach quickly, so I administered the medication as ordered. The patient experiencedsignificant pain relief with no adverse reactions, but I'm still wondering if I did the right thing. Should I feel confident about my nursing judgment, or did I just "dodge the bullet" this time?-P.O., VA.

Of course, confidence building is vital when you're starting out in nursing and trying to become an independent decision maker within your scope of practice. But in a case like this, you shouldn't try to go it alone. Ethically and legally, you need to take the extra steps necessary to ensure patient safety-for example, by trying to contact the patient's physician to confirm or explain the unusual order, calling the pharmacy for guidance, consulting with a more experienced colleague, and carefully documenting the sequence of events.

As a licensed nurse, you're responsible for administering drugs safely, regardless of what the practitioner orders. When an ordered dosage is outside normal parameters, you need to make sure it's not an error and to determine the rationale. For example, a patient who's been on long-term opioid therapy for cancer pain becomes opioid-tolerant and may receive unusually high opioid doses to manage pain without experiencing adverse reactions.

Don't proceed with drug administration if you're not satisfied that doing so is safe. Notify your manager and follow hospital policy as indicated.